AJOB Empirical Bioethics

VOL. 11 No. 2 | May 2020

In the made-for-bioethics movie Gattaca, when the main character Vincent is born, a nurse in the delivery room draws a drop of his blood, places it in the nifty instant genetic analyzer, and intones, “Heart disorder: 99% probability. Early fatal potential: life expectancy 30.2 years.” (Spoiler alert!) However, Vincent doesn’t let this genetic version of a horoscope control his life, but goes on to beat the odds — and his society’s rampant genetic discrimination — to live and succeed, proving that, contrary to his society’s beliefs, genetics are not determinative.

Now a study in the New England Journal of Medicine has confirmed the message of Gattaca. The study examined patients who have genetic risk factors known to predict heart disease (“Heart disorder: 99% probability”). It also analyzed these patients’ heart-healthy behaviors: eating a reasonable diet, getting some exercise, avoiding smoking, and the like. The study showed that even for those with the highest genetic risk of heart disease, patients who practiced heart-healthy behaviors had less heart disease than patients who didn’t; and that the patients in the highest genetic risk group had the greatest reduction in risk when they practiced such behaviors. In fact, they cut their risk in about half.

Sure, genes confer risk for heart disease. But contrary to popular understanding, they do not confer inevitability.

Over and over I hear my patients say to me, “It’s in my genes. It must be genetic.” They usually are talking about something that they feel they have no control over. Too often they have swallowed the line from the press and pop science, the line that says that genes are determinative. If you are looking to absolve yourself of responsibility for who you are and what you do, the whole determinism thing is extremely convenient: “I can’t help it: it’s in my genes,” you say, smiling gently as you take one more drink too many with your mistress while driving 85mph down the highway, comforting yourself with the “facts” that alcoholism, infidelity, and risky behavior are all genetically determined.

However, if you feel that you’re a responsible human being whose choices actually mean something, you might be thinking that the whole determinism thing is a little fishy.

Genes do exert influence. They are a risk factor in many conditions. But they have been portrayed as way more controlling than is warranted. We are not puppets dangling on doubly-helical strings. There are many things influencing our lives: environmental and socio-economic and biologic and emotional and spiritual and, yes, genetic factors. They all affect and expand or limit our choices. But it is still we who must make the choice. To the situations that affect us we are to a greater or lesser extent able to make response — we are “response-able” — and must not take refuge in our genes, or any other abstracted part of our humanity, to reduce ourselves to automatons following an inexorably pre-determined path.

Twitter

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